Foreign body gingivitis as a possible contributor to oral carcinogenesis: a clinicopathologic study

Introduction

Foreign body gingivitis (FBG) is an inflammatory reaction associated with the presence of foreign material in the gingival tissues. Si is the element most prevalent in the foreign particles and is typically found in nature as SiO2 (silica). Silica is a major component of toothpaste, pumice, polishing paste, and carborundum. We have previously reported a significant association between the presence of foreign particles and epithelial dysplasia. Herein, we aim to evaluate the clinical and histologic features of additional gingival lesions of FBG with significant epithelial changes to better characterize the histologic spectrum of the host response and epithelial findings.

Materials and Methods

Fourteen gingival lesions showing FBG and significant epithelial changes were retrieved from the archives of the Texas A&M Oral Pathology Services. Clinical records and deidentified microscopic slides were reviewed.

Results

Both sexes were affected equally, with an average age of 68.7 years. There was a strong predilection for the posterior gingiva (92.9% of cases), and the lesions were clinically suspected to be leukoplakia, proliferative verrucous leukoplakia, or dysplasia in the majority of cases. Microscopically, the predominant inflammatory cell type was lymphocytes followed by plasma cells, and the pattern of inflammation was lichenoid in 64.2%. A verrucous architecture was seen in 57.1% of the cases and varying degrees of dysplasia in 71.4 %.

Conclusion

Although the effects of silica microparticles in oral tissues are poorly understood, they have been shown to cause significant changes such as silicosis and carcinoma in the lung. Given the recent increase in the prevalence of gingival carcinomas and the wide use of nano- and microparticles in dental and household products, the biological effects of these particles in oral epithelium need to be better elucidated. Further documentation and evidence are needed, and pathologists should evaluate and document all gingival premalignant lesions for foreign material.